Scientific evidence and research in antimicrobial stewardship

Abstract

Evaluating the impact of antibiotic stewardship programs is challenging. There is evidence that they are effective in terms of reducing the consumption and cost of antibiotics, although establishing their impact on antimicrobial resistance (beyond restrictive policies in outbreaks caused by specific antimicrobial resistant organisms) and clinical outcomes is more difficult. Proper definitions of exposure and outcome variables, the use of advanced and appropriate statistical analyses and well-designed quasi-experimental studies would more accurately support the conclusions. Cluster randomized trials should be used whenever possible and appropriate, although the limitations of this approach should also be acknowledged. These issues are reviewed in this paper. We conclude that there are good research opportunities in the field of antibiotic stewardship.

Keywords: Antibiotic policy; Antibiotic stewardship; Antibiotic use; Calidad asistencial; Clinical research; Diseños epidemiológicos; Epidemiologic designs; Healthcare quality; Investigación clínica; Política de antibióticos; Programas de antibioterapia; Uso de antibióticos.